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179 Cards in this Set
- Front
- Back
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First line therapy for hypertensive diabetic?
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ACE
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Rule of 9's for burns
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Entire arm: 9%, ant 4.5% post 4.5%
Anterior surface of each arm: 9% Posterior surface of each leg: 9% Abdomen 9% Chest 9% Genitals 1% Anterior head 4.5% posterior head 4.5% |
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What is the most effective imaging for evaluation of chronic sinusitis?
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Coronal CT- determines anatomy of sinuses and presence and extent of sinusitis
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First line tx of an initial case of gouty arthritis?
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Indomethacin
-a NSAID Colchicine is useful for adjunct to NSAID, cortico, refractory cases, or as a preventative |
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When would you use colchicine for gout?
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Colchicine is useful for adjunct to NSAID, cortico, refractory attacks, or as a preventative
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When would you use allopurinol?
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more than 3 occurrences per year
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What test is most sensitive to diagnose HSV?
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PCR
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S3 and S4 gallops are signs of which type of cardiac abnormality?
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Ventricular dysfunction
S3 may be louder if filling pressure is incr or vent compliance is reduced S4 is mc heard with incr resistance to filling bc of loss of compliance of the vent walls or the incr stroke vol of high output states |
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What are characteristics of essential tremor?
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Can be familial, and can cause hand, head, or voice tremor. Lower ext are spared and no other neuro findings. Alcohol can help.
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Which is most likely to cause a false negative PPD?
Aspirin allergy, dx of AIDS, BCG immunity, pregnancy? |
Diagnosis of AIDs
-any process that results in reduced immune response |
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Which would result in a false positive PPD?
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BCG immunization
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What is pellagra?
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Niacin (vit B3) def. Seen in people where corn is major source, endemic in Africa.
Glossitis, pigmented dermatitis, dementia, diarrhea. |
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Recent stroke, systolic ejection murmur, 2nd hs is fixed and widely split, what is the diagnosis?
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Patent foramen ovale. Present in 25% of the population, and can lead to paradoxic emboli cerebrovascular events. High suspicion in patients who have stoke before age 55.
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What is parovirus B19 associated with in children?
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Fifth disease
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Who should undergo one-time screening for AAA, even is symptomatic?
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65-74 year old healthy men who have h/o smoking, but not women.
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What is the pharmacologic choice in males with gynecomastia?
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Selective estrogen receptor modulator (SERMs)
-ex are tamoxifen and raloxifene |
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MCC of small bowel obstruction?
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Peritoneal adhesions.
Xray- dilated loops of small bowel with air-fluid levels. |
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What is the initial tx for acute angle closure glaucoma?
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Topical pilocarpine (pupilary constriction)
Atropine would dilate! |
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What does Nifedipine (pericardia) do?
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CCB, prevents calcium entry into muscle cells, commonly used for tx of preterm labor.
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Mgmt of moderately displaced C1 atlas fracture?
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Halo vest- indicated in cases involving moderately displaced fx.
Cervical traction is not indicated for C1-C2 fx, instead, immobilization. |
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What is the mgmt for minimally displaced C1 fx?
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Cervical collar immobilization
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When should surgical fusion of C1-C2 take place?
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For pts with remaining instability, or posterior arch disruption after 3-4 months of halo vest tx.
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Most effective tx for outpatient mycoplasma pneumonia?
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Doxy
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Hypoparathyroidism labs?
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low serum calcium, high serum phosphate, low urine calcium, normal alk phos, low PTH levels
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4 year old with headache and new onset confusion. Viral illness 2 wks ago. Petechiae and purpura on legs. Low platelets. Next step?
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CT. Concern is low platelets and internal bleed. Complaining of a headache would warrant a CT to eval for intracranial bleed.
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Which labs would differentiate seizure from pseudo seizure?
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Serum prolactin. It can briefly rise after a seizure.
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Repeated syncopal episodes, wide QRS complex with fixed R-R interval at rate of 40. P waves occur with a fixed P-P interval at 70. PR interval invariable. TX?
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Transthoracic pacemaker type 3 block
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What is the most common cause of transudative pleural effusion?
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CHF
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What kind of effusion do lung cancer and pneumonia cause?
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Exudative
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Which is initial choice for status epilepticus?
Phenobarbital, Valproic acid, Lorazepam, Porpofol |
Lorazepam (Ativan)
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65 yo new onset right eyelid droop. Ptosis, anhydrous, miosis. What is underlying mechanism a/w this presentation?
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Horner's syndrome is the result of cranial sympathetic dysfunction that occurs due to nerve injury below the level of entry into the skull.
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What does dysfunction of 7th cranial nerve result in?
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Facial muscle paralysis.
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What does autoimmune dysfunction of neuromuscular transmission result in?
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myasthenic syndromes such as myasthenia gravis
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What does dysfunction of the 5th cranial nerve result in?
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Facial sensory loss and altered motor function of the temporalis and masseter muscles.
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What can be used as a prophylaxis for recurrent cystitis?
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nitrofurantion (Macrodantin)
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Chronic hypertension in a pregnant patient definition?
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Defined as present before 20 wks of htn before pregnancy
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Eye screening for DM 2 without evidence of retinopathy?
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annually
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Eye screening for mild to moderate non proliferative retinopathy?
Proliferative retinopathy? |
6-12 months.
every 3 months |
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Prerenal azotemia symptoms
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n/v, malaise, confusion. Prerenal causes are most common and include hypovolemia.
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Postrenal azotemia causes
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Uncommon, result of obstruction of flow from both kidneys. Caused by ureteral obstruction and bladder obstruction. Kidney stones of BPH are common causes.
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Absent breath sounds, increased tactile fremitus and egophony.
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Pneumonia -> increased density of pulmonary tissue
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Which lab should be followed in pts with atypical antidepressants?
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FBS, on a quarterly or semiannual basis.
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Mycobacterium avium complex, with out without evidence of HIV, is considered definitive of what?
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AIDS.
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HIV with CD4 under 200 is diagnostic of what?
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AIDS
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Non-Hodgkin lymphoma with evidence of HIV is diagnostic of what?
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AIDS
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HIV with pneumocystis jiroveci pneumonia is diagnostic of what?
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AIDS
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Scoliosis Cobb angle is 65 degrees. What is indicated at this time?
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Patients with 60-90 degree curves, those with resp complaints, and those with scoliosis from a neurmuscular cause should undergo PFTs because at risk for cardiopulm compromise and secondary restrictive lung disease.
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Which is most likely found in a pt with anemia, low factor VIII, and prolonged PTT?
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Arthropathy; hemarthrosis is likely in factor VIII def (hemophilia A)
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Osteomalacia responds to what tx alone?
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Vit D
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What is the tx of choice for Paget disease (osteitis deformans) of the bone?
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bisphosphonates
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Best tx for osteoporosis?
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Vit D + Calcium
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Globe rupture mgmt?
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Rigid shield over eye
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Hypertension, hematuria, and dependent edema are classic symptom triad of what kidney disease?
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Nephritic syndrome
-edema first seen in areas of low tissue pressures such as periorbital and scrotal areas -htn due to vol overload -hematuria may or may not include rbc casts |
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Heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema?
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Nephrotic syndrome
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Constellation of glomerulonephritis and pulmonary hemorrhage?
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Goodpasture syndrome
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Best tx for hypertensive emergency?
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nitroprusside sodium
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What is the esmolol only approved for?
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SVT
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Vasopressin challenge test for which endocrine disorder?
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Diabetes insipidus
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Thrombolysis is contraindicated within how many days of major surgery?
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10
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Best mgmt for basal cell carcinoma?
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Any lesion suspected of being BCC should be punch biopsied.
Excision done after confirmation of dx by the biopsy |
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Which type of kidney stone occurs secondary to infections due to urease-producing bacteria?
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Struvite; commonly seen in women with recurrent UTI
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Koplik spots?
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measles
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Gray membrane coating the pharynx?
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Diptheria
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White pharyngeal exudates?
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strep pharyngitis
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strawberry tongue?
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Kawaksaki or scarlet fever
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RCA responsible for which wall of the heart?
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Inferior, II, III, aVF
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Left Anterior Descending (LAD) responsible for which wall of the heart?
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anterior, V2-V4
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Occlusion of circumflex artery or diagonal branch of the LAD will affect which wall?
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Lateral wall, V5-V6
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Posterior wall blood supply?
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RCA and circumflex artery. ST dep and tall, upright R and T waves in leads V1-V3
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Herpangina?
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a/w enteroviruses, presents with painful vesicles about the tonsillar fauces.
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What is the posterior column responsible for?
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vibratory sensation and proprioception. Romberg test is for proprioception.
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Recent viral pericarditis, now c/o dyspnea and non-productive cough over pericardial region. HR 130. BP fluctuates with inspiration with 20 mmHg decline in systolic pressure. Therapy?
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This pt has pericardial tamponade, urgent pericardiocentesis is required
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Pt on infliximab (remicade) for RA should be screened for which disease prior to starting the meds?
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TB. Pts on TNF inhibitors are at greater risk of developing infections.
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Which type of hemoglobin is responsible for sickle cell anemia?
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SS
A, AS is a/w sickle cell trait F is seen in someone successfully undergoing tx for sickle cell |
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Acute inflammatory pericarditis
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anterior pleuritic cp that is worse supine than upright. EKG diffuse ST elevation with associated PR depression. Viral infections are MCC. Tx is ASA or NSAIDs
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Young, healthy pt with recent viral syndrome followed by acute, sharp, focal CP, NOT worsened by chest wall palpitation?
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Pleuritis
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Pneumovax indicated for who younger than 65?
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chronic alcohol users
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65 yo F, severe abd pain, n/v, wbc 19000, tri 1100, glucose 280?
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Acute pancreatitis. Abd pain, N/V, sign hypertriglyceridemia, transient hyperglycemia. additionally, elevated amylase/lipase, alk-phos.
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What PE findings indicates the delivery of the placenta in imminent?
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Uterus rises and is more globular in abdomen, gush of blood, lengthening of umbilical cord.
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Ankylosing Spondylitis
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Low back pain >3 months. Morning stiffness relieved by exercise. Uveitis affects up to 40%. Diminished forward flexion and dec chest expansion on inspiration.
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Ankylosing Spondylitis is associated with what eye problem?
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Anterior uveitis
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Radiographic ankylosing spondylitis
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Erosions in SI joint line, pseudowidening, subchondral sclerosis, bony replacement of SI joint, squaring of vertebral bodies.
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What spinal condition is most frequent finding in osteoporosis?
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Vertebral compression fracture
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Lesion of left optic tract?
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Dysfunction of the right temporal and left nasal visual fields. This leads to right homonymous hemianopsia.
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Lesions of left optic nerve?
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Left eye blindness
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Lesions of right optic nerve?
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Right eye blindness
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Right optic tract dysfunction
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Left homonymous hemianopsia
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Most appropriate diagnostic study for pyloric stenosis?
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Upper GI contrast radiographs
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Most appropriate diagnostic and therapeutic study for intussusception?
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Barium enema
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How does intussusception usually present?
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Recurring paroxysms of abd pain, vomiting and bloody diarrhea.
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Definitive tx for severe obstructive sleep apnea?
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Tracheostomy.
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High fat diet and prostate cancer?
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high fat diet has been implicated in dev of prostate cancer. Smoking, prior prostatitis, current BPH, sexual activity, has shown no association.
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80 yo smoker, progressive dysphagia for solids x 6 months. Regurgitates food, "gets stuck," unintentional 20 lbs weight loss.
Diagnostic test? |
Barium esophagography. Esophageal neoplasms most likely. BUT, less invasive initial test would be barium swallow.
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When would you use esophageal manometry?
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Manometry measures esophageal pressures which are reduced in GERD or elevated in certain conditions such as achalasia
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When would you use esophageal motility studies?
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Indicated in dysphagia of both solids and liquids looking for motor dysfunction.
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When is urgent cardioversion indicated in Afib?
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With shock or severe hypotension, pulmonary edema, or ongoing MI or ischemia.
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When would you use radio frequency ablation?
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Wolff-Parkinson-White syndrome, or other aberrant pathways
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Tx of otitis externa?
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Keep external canal clean and dry. Topical abx, with gram neg coverage such as ciprofloxacin
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Stage I, II, III hemorrhoid, with recurrent bleeding, not responsive to conservative tx?
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Injection sclerotherapy, rubber band ligation, or application of electrocoagulation.
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Stage III or IV hemorrhoid and chronic bleeding tx?
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Hemorrhoidectomy
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MRI findings in MS?
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Multifocal white matter disease
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Pleural effusion: percussion and tactile fremitus?
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Dull to percussion (increased density from effusion), and decreased tactile fremitus (speech vibration reduced)
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Emphysema: percussion and tactile fremitus?
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Hyperresonanace and increased fremitus.
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Nocturnal enuresis tx and side effect?
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Desmopressin nasal spray, potential to cause hyponatremia.
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Target BP for patients with DM or CKD?
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130/80
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Impetigo tx?
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TX topical mupirocin followed by oral cephalosporin. Infection of the skin,caused by S aureus or S pyogenes,characterized by honey crusted erosions.
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Tx of choice for small-cell carcinoma?
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Combination chemotherapy.
If limited small-cell (no mets), thoracic radiation can be beneficial. |
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Smith's FX?
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dorsally angulated fx of the distal radius
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Monteggia FX?
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fx of the proximal third of the ulnar diaphysis with anterior angulation or anterior dislocation of the radial head
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Nightstick FX?
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isolated fx of the ulna with nondisplacement or minimal displacement, most commonly from a direct blow to the ulna.
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Chauffeur's FX?
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radial styloid fx
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What is MEN-I?
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Multiple endocrine neoplasia. Familial tumor syndrome.
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What is the initial biochemical manifestation of MEN-I?
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Hypercalcemia, can be detected as early as 14-18 yo, but clinical sxs usually don't present until 3rd or 4th decade.
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What is the corneal light reflex used to screen for?
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Strabismus.
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Most common vitamin def cause of blindness in developing countries?
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Vit A def. Secondary to malabsorption disorders and frequent mineral oil laxative use. Night blindness is one of the earliest symptoms.
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Rocky Mountain Spotted Fever tx
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Doxy. h/a, fever, faint macular eruptions on ankles and wrists
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Excess of prostaglandin F2 alpha produced in the endometrium causes what?
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Primary dysmenorrhea.
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Carbuncle with early cellulitis tx?
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I and D, with wound culture followed by oral abx.
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Recent from Southeast Asia, 6 m h/o wt loss, frequent cough with hemoptysis and fever. Sputum smear acid fast bacilli. Whats dx and what labs for routine tx?
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Tuberculosis, treated with several hepatotoxic agents which require monitoring of liver function-> AST/ALT.
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When should a pt with a first degree relative with colon cancer dx at 60 or after be screened?
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Age 40 with colonoscopy
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Septic arthritis organisms?
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Yersinia and Salmonella. Limited to the joints.
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Osteomyelitis organism?
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S aureus, in the metaphysis of long bones. Destruction of the bone.
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Osteomyelitis gold standard dx?
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Bone aspiration of the lesion.
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Ewing Sarcoma?
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Presents similarly to acute osteomyelitis, however, small round cells are seen signaling sarcoma, not infection.
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What is required for the initiation and maintenance of the menstrual cycle?
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Pulsatile secretion of GnRH
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Treatment of choice for ALL?
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Combination chemotherapy
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What is the initial tx of choice for a Baker's cyst?
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Intra-articular injection of corticosteroid to dec inflammation effect.
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Cor Pulmonale classic presentation?
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COPD. Peri edema. JVD, epigastric pulsations, tender hepatomegaly. Systolic ejection murmur.
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What is cor pulmonale most commonly cause by?
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COPD
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Dialysis should be started in a nondiabetic pt when the GFR reaches? OR when serum creatinine rises to?
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GFR = 10 mL/min
Serum creatinine = 8 mg/dL In diabetic pt, GFR 15, serum creatinine 6 |
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Lewy Body disease?
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Similar to Alzheimer's. Characterized by hallucinations, parkinsonian features. Lose cholinergic neurons->loss of cognitive function. Lose dopaminergic neurons->loss of motor function. Very sensitive to neuroleptic and anitemetic meds that effect dopaminergic and cholingergic systems -> respond with catatonia, loss of cognitive function and or develop life-threatening muscle rigidity
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Clozapine and agranulocytosis
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1-2% incidence. Patient should promptly report if fever, sore throat, weakness or other signs of infection. Must be d/c if the WBC drops below 3,000 or 50% of patients normal count.
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Guillain-Barre
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Acute inflammatory demyelinating disorder. Progressive distal-proximal weakness, first noticed by gait abnorms.
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Most common cause of sensorineural hearing loss in adults?
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Presbycusis.
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First line of tx for endometriosis?
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Oral contraceptives. Often with NSAIDs.
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Best method to demonstrate pericardial tamponade.
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Echo
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Vestibular neuritis
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Sudden onset of vertigo, nausea, vomiting, in the absence of auditory or focal neurologic abnormalities. May persist several days, and often follows acute viral illness.
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Lachman's test?
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ACL. Noncontact ACL injuries: Deceleration and rotational injury while running, jumping, cutting. Contact: hyperextension and/or valgus forces from direct blow to knee.
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McMurray test?
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Meniscal injuries
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Posterior drawer test?
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Posterior cruciate ligament injuries
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What therapy can reduce the risk of rebleeding after endoscopic treatment in patients with peptic ulcers with high risk of active bleeding?
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IV pantoprazole (Protonix)- IV proton pump inhibitor
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FHS is ____ ,estradiol is _____ , LH is _____ in menopause
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Increased FSH (>30mIU/mL)
Decreased estradiol Increased LH |
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PE findings in chronic aortic regurg?
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Wide pulse pressure
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Widened pulse pressure causes
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Atherosclerosis
Chronic aortic regurgitation Thyrotoxicosis Fever Anaemia Pregnancy Anxiety Patent ductus arteriosus Heart block Aortic dissection Endocarditis Raised intracranial pressure |
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Tx for Legionellosis?
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Azithromycins, also with quinolones and tetras.
Rifampin can be used in combo, but never alone |
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14 yr old with painful "bump" on right lower extremity just below knee and a/w pain during and after activity. Exam reveals prominent tender tibial tubercle. Dx?
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Osgood-Schlatters painful swelling over tibial tubercle, most commonly in male adolescent athlete.
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Who does patellofemoral syndrome most commonly affect?
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Female adolescent athletes.
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What is osteochondritis dissecans?
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Occurs most commonly in knee when a focal area of bone and adjacent cart. are affected by vascular necrosis.
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Dev. milestone of speaking 1-3 words should be reached by which age?
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12 months
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Long history of COPD, worsening dyspnea, severe resp distress (pao2 40, paCO2 65, ph 7.25). What mgmt?
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Endotracheal intubation and mechanical ventilation
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Tx for blepharitis?
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Erythromycin ointment, for S aureus.
Can use lid scrubs for sx relief |
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Rh negative women tx with Rh immune globulin when?
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Rh neg women are screened on initial and 28 weeks for ab to Rh antigen. If she is ab neg, she will receive Rhogam at 28 weeks and within 72 hours of birth of Rh pos baby.
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When is Rhogam used prophylactically?
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When any event takes place in the pregnancy where there is risk of fetomaternal hemorrhage that could lead to maternal exposure to fetal rbcs: abortion, ectopic preg, bleeding a/w previa or abruption, amniocentesis, CVS...
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Pt admitted with acute non-ST MI 3 days ago, confirmed by elevated CK, CK-MB, trop 1 and 2. He has recurrent cp. Which lab to eval recurrent cp?
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CK-MB normalizes within 8-12 hours, so helpful for eval of reinfarction.
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How long do troponins last?
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5-7 days, more sensitive than CK-MB
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Which cardiac marker elevates soonest?
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Myoglobin, but are non-specific, and not useful for marker of specific cardiac injury
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What can Bentyl (Dicyclomine) be used for?
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Along with other anticholinergics, can help relieve abd sxs of cramping and bloating a/w IBS
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SSRIs and akathisia
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akathisia is neuroleptic induced movement syndrome that usually occurs in the beginning of tx. Pts appear to be in constant motion and anxious.
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CXR: Unilateral findings of a visceral pleural line with a radiolucent area devoid of vascular markings on one side only.
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Pneumothorax
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Ciliary injection, engorgement of the vessels about the limbus is a characteristic findings in a pt with what?
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Corneal foreign body
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What is most appropriate therapy to slow the progression of osteoporosis?
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Biphosphonate is first line oral therapy.
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Horner syndrome and apical lung cancers?
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A non-pulm PE finding a/w apical lung cancers. Constricted pupil, partial ptosis, loss of sweating.
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CXR of adenocarcinoma of lung?
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Solitary, peripheral lesion. Sometimes a/w ipsilateral pleural effusion.
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Ciliary injection, engorgement of the vessels about the limbus is a characteristic findings in a pt with what?
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Corneal foreign body
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Hallmark finding that is essential to the dx of primary dilated cardiomyopathy?
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Systolic dysfunction and left ventricular dilation
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What is most appropriate therapy to slow the progression of osteoporosis?
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Biphosphonate is first line oral therapy.
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Pt with blunt abd trauma, Grey Turner's sign, preventive mgmt?
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For a pt with functional or anatomic asplenia, pneumococcal vaccine should be given as the spleen is specifically responsible for combating infection by strep pneumoniae.
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Horner syndrome and apical lung cancers?
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A non-pulm PE finding a/w apical lung cancers. Constricted pupil, partial ptosis, loss of sweating.
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Austin Flint murmur
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mid or late diastolic low-pitched mitral murmur heard in advanced aortic regurg.
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CXR of adenocarcinoma of lung?
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Solitary, peripheral lesion. Sometimes a/w ipsilateral pleural effusion.
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Dx test for lactose intolerance?
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Hydrogen breath test
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Hallmark finding that is essential to the dx of primary dilated cardiomyopathy?
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Systolic dysfunction and left ventricular dilation
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what is the moa of cromolyn sodium in asthma
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Mast cell stabilizer. Prevents release of inflammatory chemicals such as histamine from mast cells.
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Pt with blunt abd trauma, Grey Turner's sign, preventive mgmt?
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For a pt with functional or anatomic asplenia, pneumococcal vaccine should be given as the spleen is specifically responsible for combating infection by strep pneumoniae.
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What's the most common cause of pulmonary edema?
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Left sided heart failure
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Austin Flint murmur
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mid or late diastolic low-pitched mitral murmur heard in advanced aortic regurg.
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Dx test for lactose intolerance?
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Hydrogen breath test
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what is the moa of cromolyn sodium in asthma
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Mast cell stabilizer. Prevents release of inflammatory chemicals such as histamine from mast cells.
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What's the most common cause of pulmonary edema?
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Left sided heart failure
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